The renin--angiotensin--aldosterone system during cardiac surgery with morphine--nitrous oxide anesthesia.

Ten consecutive adult patients undergoing elective cardiac surgery with extracorporeal circulation were anesthetized using morphine (1-3 mg/kg) and nitrous oxide. Pre-bypass plasma renin activity showed a 3.5-fold elevation (P smaller than 0.001) over baseline values. This correlated with maximal blood pressure elevation. Plasma renin activity remained elevated during bypass. High baseline aldosterone levels increased 3.4-fold (P smaller than 0.001) after 15 minutes on bypass and 4.0-fold by the end of bypass. Plasma potassium decreased from 3.9 mEq/1 before bypass to 3.2 mEq/1 (P smaller 0.0001) during bypass, and the fractional urinary excretion of potassium was 32 per cent before bypass with a mean of 34.4 per cent during bypass. Urinary output remained high during bypass despite a progressive decrease in glomerular filtration rate. Catecholamine levels showed no significant change. The data suggest that the renin-angiotensin-aldosterone system may play a role in blood pressure regulation during cardiopulmonary bypass and may result in the excessive urinary excretion of potassium and decrease in plasma potassium levels.